New PMD LCD, Nov. 15 Extension Are Announced

Oct 01, 2006

As this issue went to press, the medical directors of the Medicare Durable Medical Equipment Program Safeguard Contractors (DME PSCs) released a revised local coverage determination (LCD) for power mobility devices (PMD) and postponed implementation of the new policy from Oct. 1 to Nov. 15, 2006.

The revised LCD was released Sept. 20, as much of the industry was attending Medtrade in Atlanta.

Among the LCD changes was eliminating of "downcoding" beneficiaries from Group 2 or 3 power chairs to Group 1 power chairs if beneficiaries didn't meet certain criteria. The revised LCD also added "independently" to the requirement that a Group 3 beneficiary be "unable to stand and pivot or transfer due to a neurological condition or myopathy." That criterion now reads, "The patient is unable to independently stand and pivot to transfer due to a neurological condition or myopathy."

At press time, the industry was awaiting fee schedules for the new PMD codes. Questions also remained regarding how the LCD would be interpreted by claims reviewers.

Don Clayback, The MED Group's director of networks, says one concern is access to higher-end assistive technology. "There's been some improvement in the Group 2 category," he notes. "It looks like people who qualify for the Group 2 wheelchair classification will stay in Group 2, but the concern (is) for people with more complex disabilities that should be put int a Group 3 type of wheelchair. (Their access) may still be eliminated based on the stand/pivot transfer clause we still have to define 'independtely.' I think we need to get that clarified. Some clinicians are putting together case studies; there may be people that can do an independte transfer and still be qualified for that Group 3 type of wheelchair."

"The other question," Clayback says, "is to really go through each sentenced in the policy to see what gray areas still remain in terms of classifications and who is going to end up within each category. What's obvious is the stand/pivot clause is still a significant concern. The broader concern is also what kind of person is going to be recommended for a Group 3 wheelchair that may in fact get downcoded to one of those other chairs that won't meet their needs."

Go to www.tricenturion.com/content/currentbulletin_dyn.cfm and look under Current Bulletins to download a copy of the revised LCD. Mobility Management's November issue will include in-depth coverage of the PMD LCD, as well as a special editorial section on power chairs.

McClellan Announces October Resignation

Dr. Mark McClellan, Centers for Medicare & Medicaid Services administrator, will be leaving his post by early October 2006, he announced last month.

In accepting the resignation, President Bush said, "Mark McClellan has served my administration in a number of pivotal positions, and in doing so has bettered the lives of millions of Americans. He played an instrumental role in transforming the nation's health care system, and his efforts will continue to make a difference for generations."

McClellan said in a statement that the decision to leave was difficult, "because this is the most exciting and rewarding place that anyone could ever work. But I've been in government service for much longer than my family and I had ever expected or prepared for, and after almost six years in this administration plus service in the previous administration as well, I'm looking forward to more dinners at home with (wife) Steph and our daughters."